At first, we thought the hardest part was convincing our Mom that she shouldn't drive any more.
But two years after getting Mom to relinquish the car keys, my two older siblings and I are learning that taking care of an aging parent has many, many 'hard parts.' Moreover, we've learned that the American healthcare system isn't terribly helpful to adult children of modest means who want to provide a safe, clean, engaging living arrangement for aging parents of limited means.
The endless debating between the White House and members of Congress on the Federal budget in general and Obamacare in particular is frustrating to observe. I live in suburban Washington, D.C., and I can confidently report that the gridlock between the House and the Obama Administration is real -- and that many millions of Americans are suffering needlesly while pols dither and posture.
Specifically, millions of Americans are withering away in the perilous throes of our long national healthcare nightmare. In March 2010, the Affordable Care Act became law. For folks in my Mom's age group (65+), according to market research on the healthcare act conducted by AARP, the Act was designed to:
- Strengthen Medicare.
- Lower the cost of some prescription drugs.
- Provide additional funding for states to direct toward long-term care for elders, mostly in the form of increasing inspections and safety measures at senior facilities.
These are important improvements, but they are not expansive or as yet being felt by millions 'on the ground' in many states for a host of reasons. I understand that it will take longer than two years for the full positive effect of that landmark legislation to actually filter down to regional and local systems in a manner that masses of consumers will actually be able to measure. But I am concerned that there remain other healthcare system shortcomings -- as well as related economic and cultural aspects -- that will take many more decades to correct.
For instance, a new report from the Journal of American Medical Association outlines analysis by the National Research Council and the Institutes of Medicine on the state of the American healthcare industry relative to other developed nations worldwide. The two nonpartisan, research-focused organizations delivered a sobering assessment that reads in part:
"...US males and females in almost all age groups—up to age 75 years—have shorter life expectancies than their counterparts in 16 other wealthy, developed nations: Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom. The scope of the US health disadvantage is pervasive and involves more than life expectancy: the United States ranks at or near the bottom in both prevalence and mortality for multiple diseases, risk factors, and injuries."
"The United States lacks universal health insurance coverage, and its health system has a weaker foundation in primary care and greater barriers to access and affordable care. Care coordination also is a problem."
We are intimately familiar with that last point -- the lack of 'care coordination' of the existing system.
Right now, my 82 year-old Mom is in pretty decent shape, physically. Her mind though, is slipping, and while we're grateful that the diagnosis isn't Alzheimer's, she is in the realm of dementia: Her long-term memory is far sharper than her short-term memory, resulting in periods of forgetful behavior and lapses of judgement that make it unsafe for her to live alone. A retired Federal government worker, my Mom has a pension that is 'decent' -- and yet, given that her home city, San Francisco, is one with an exhorbitantly high cost of living index, her living expenses out -pace her annual resources. (And not because she is profligate, it is because her pension benefit can't keep up with the escalating cost of everything in the San Francisco Bay Area in recent years, including groceries, housing, insurance and other staples.)
Since I live three thousand miles away, most of the case management for my Mom has fallen to my older sister, bless her. She has managed the transition of our Mom out of the family home in San Francisco into a senior apartment complex where round the clock care is available. All of this my sister managed while juggling her own school-aged children, her college and post-college work. My brother -- bless him, too! -- recently relocated his family from Seattle back to the Bay Area in order to be more helpful.
And yet, since we all three have our own families and the time-crunches and financial obligations that they entail, we are experiencing stress on several levels. We are part of "Generation Squeeze,' meaning that as we each enter our 50s, we are coping with funding our respective children's continuing educations, and the escalating cost of caring for our Mom, too. In purely financial terms, we are making it work although without much in the way of cushion... which raises a key question about the not too-distant-future: How will we be able to afford additional care for our Mom when that time arrives? We don't qualify for most of the senior programs available to low-income Bay Area residents and yet as we contemplate the various cost scenarios for our Mom's future care, we are coming to see that we may encounter significant shortfall in the years to come.
Still, I realize that we are more fortunate than most: We are all educated, have middle-class jobs and an abundance of love for our Mom. But the future of our ability to continue providing Mom with great care is far from certain. And I can't imagine what this same dynamic is like for families that have fewer resources than we do.
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